question

airways surrounded by smooth muscles

answer

smooth muscle controlled by autonomic nervous system

question

when sympathetic nervous system stimulated

answer

bronchiolar smooth muscle relaxes and bronchodilation results; --allows more air to enter alveoli, increasing oxygen supply to body

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asthma is a chronic lung disease characterized by

answer

inflammation of the airways and bronchoconstriction, which improves either spontaneously or after treatment

question

cell mediators

answer

narrow the airway --by causing edema and inflammation, and cause bronchoconstriction --by stimulating the airway smooth muscles to contract

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T lymphocytes,

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WBC's involved in inflammation reactions

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eosinophils

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WBCs involved in allergic and inflammatory reactions

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mast cells

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make histamine, which is released during allergic reaction in response to an allergen

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processes that result in airway obstruction

answer

bronchoconstriction, inflammation, loss of lung elasticity

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airway obstruction increases airway resistance, resulting in

answer

more work, difficulty breathing, reduced blood oxygen levels

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triggers include

answer

allergens like dust, pollen, smoke, pet dander; excercise, stress; changes in weather, most often: upper respiratory viral infection

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atopy

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genetic susceptibility to produce IgE antibodies; --IgE is associated with development of allergies, --associated with asthma in children

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inflammation may be controlled with

answer

anti-inflammatory/corticosteriod agents, but NOT completely eradicated

question

airways become obstructed by mucous, then swelling of airway linings, then smooth muscle contraction, called

answer

bronchospasm; --leads to further airway obstruction

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airway hyperresponsiveness and airway obstruction leads to

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cough, shortness of breath, wheezing, --also breathlessness/dyspnea, chest tightness

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bronchospasm mediated through B2 receptors on bronchioles

answer

rapidly relieved by inhaled bronchodilators

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acute exposure, like allergy or exercise, causes acute bronshospasm

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early asthmatic response

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airway inflammation comes on more slowly

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late asthmatic response

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loss lung elasticity results from air sac enlargement, or distention

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takes long-term, high dose therapy

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clinical diagnosis of asthma confirmed by

answer

pulmonary function testing showing reversible airflow obstruction; --and signs that worsen at night, waking in morning, during exercise, with colds or exposure to allergens

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quick-relief medications, or acute rescue medications

answer

quick reversal of acute airflow obstruction and relief of bronchospasm

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bronchodilators/rescue inhalers

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short acting B2 agonists/SABAs, anticholinergics, systemic corticosteroids

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long-term control medications, or long term preventive, controller or maintenance medications

answer

taken daily on long-term basis to achieve and maintain control of persistent asthma; --have anti-inflammatory effects

question

anti-inflammatory drugs for long term control

answer

--inhaled corticosteriod/ICS, --Selective long-term B2-agonist/LABA, --mast cell stabilizer to inhibit histamine release, --leukotriene modifier, --immunomodulator

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stepwise approach to managing asthma based on

answer

severity and control; increase when severity increases, and decrease when under control; --start with highest appropriate therapy and work step down as patient improves

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inhaled medications preferred because

answer

high therapeutic ratio; --high concentrations of drug delivered to airways with few systemic adverse effects

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asthma control defined as

answer

use of quick-relief medications no more than twice a week and no interference with regular activities

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intermittent; step 1

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2 days week or less, --with awakening less than twice a month, --no medications needed, --rescue inhaler/albuterol when needed

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mild persistent; step 2

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more than 2 days a week, but less than one time a day; --waking twice a month or more; --daily med, low-dose inhaled corticosteroid preferred, or Cromolyn

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moderate persistent, --step 3 and 4

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every day; --daily med required, --low-dose ICS plus LABA preferred, --or low dose ICS plus leukotreine modifier or theiophylline, --then medium dose ICS plus LABA,

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severe persistent, step 5 and 6

answer

most of time; --daily med required, --high-dose ICS plus LABA, --then high dose ICS plus LABA plus oral corticosteroid

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theophylline or aminophylline not recommended to use in addition to high-dose B2 agonists/ICSs because

answer

little additional benefit and increased likelihood of adverse effects

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epinephrine/adrenaline indicated for

answer

acute treatment of anaphylaxis; --not for treatment of asthma because not B2 selective, causes more cardiac stimulation

question

routes of drug administration

answer

inhaled or systemic; --inhaled directly to airways more effective with shorter onset of action than when administered orally, --nebulizer, dry powder inhaler or metered-dose inhaler

question

rescue medications for prompt relief of bronchospasm

answer

SABAs preferred, anticholinergics, inhalers and systemic corticosteroids

question

bronchodilators; --short acting B2 agonists, or SABAs

answer

--quickest onset, 5-15 min; --relief of symptoms by relaxation of bronchial smooth muscle, --albuterol, or Ventolin, Proventil, --administered by inhalation, tablets, liquid or injection, --should be used in all patients to treat acute symptoms,

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regular daily use of rescue inhalers not recommended because

answer

tachphylaxis, due to overstimulation of receptors, which may reduce their effectiveness; rapidly diminishing response. --if needed frequently, indication that more controller therapy needed, --tachycardia and tremor more frequent if overused

question

epinephrine contraindicated in patients

answer

with uncontrolled hypertension, hyperthyroidism, and narrow-angle glaucoma

question

ephiderine also causes vasoconstriction, and available in OTC products

answer

but newer selective B2 agonists have replaced it because of links to stroke and heart attack because of B1 receptor activity

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anticholinergic agents

answer

used when patients cannot tolerate B2 agonists, or as an adjunct for additional relief of bronchoconstriction; --they reduce symptoms of cough, wheezing and chest tightness, --not sufficient when used alone, --not used for allergen or exercise-induced asthma, --ipratropium bromide/Atrovent

question

adverse affects of anticholinergics

answer

xerostomia, taste alteration. --patient should rinse mouth after each dose

question

systemic corticosteriods

answer

used when asthma cannot be controlled by bronchodilators alone; --prednisone, --used for acute asthma, not long-term maintenance/prevention; --avoid aspirin b/c GI problems

question

long-term preventive medicines: inhaled corticosteriods/ICSs

answer

for persistent asthma; --efficacy down to age 1, --most potent and effective anti-inflammatory; should be first-line therapy for long-term management; --budesonide/Pulmicort, beclomethasone/Beclovent

question

adverse effects of inhaled corticosteroids

answer

cough, oral candidiasis/thrush, growth suppression with high doses

question

for moderate to severe asthma

answer

combination therapy with inhaled corticosteroid and a long-acting B2 agonist

question

selective long-acting B2 agonists/LABAs; --bronchodilators

answer

--slameterol/Serevent, Advair, --formoterol/Foradil; --may allow a reduction of the dosage of corticosteroid used, --should NOT be used alone b/c overstimulation of B-agonist receptors, making SABAs less effective

question

adverse effects of LABAs

answer

--xerostomia, --black box warning for increased risk of asthma-related deaths: use only as additional therapy, --tachycardia, --headache, --overstimulation of B-agonist receptors when used alone, making short acting agonists less effective

question

methylxanthines

answer

theophylline and aminophylline, --bronchodilators that relax smooth muscle, --no longer recommended for acute attacks; --caffeine is a type of methylxanthine, --drug interactions with concomitant erythromycin or clarithromycin

question

mast cell stabilizers

answer

inhibit release of histamine and other mediators of allergic reaction leading to airway inflammation --Cromolyn sodium and nedocromil sodium; --administered by inhalation; --alternative treatment in mild persistent asthma

question

leukotriene modifiers

answer

block arachidonic acid derivatives/leukotrienes in inflammatory pathway; --orally administered; --alternative first-line treatment for mild persistent asthma, or adjunct to inhaled corticosteroids for more severe disease, --montelukast/Singulair

question

montelukast/Singulair

answer

once-a-day dosing, approved for young children, reduce need for short-acting inhaled B2 agonists

question

immunomodulators

answer

adjunct for patients with severe allergic asthma who cannot be controlled with ICSs; --Omalizumab

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COPD; bronchitis/emphysema

answer

disease that causes chronic obstruction of air flow; --bronchitis characterized by excessive mucous in bronchi, causing a mucous producing cough, --emphysema an irreversible destruction of alveolar walls with dilation of air spaces

question

COPD treatment/management; --step approach, based on severity I-IV, --productive cough to out of breath on mild exertion

answer

no cure; goal: improve chronic obstruction and treat and prevent acute episodes; --smoking cessation, then bronchodilators for mild disease and long acting drugs as becomes more chronic, --ipratropium bromide inhaler, a B2 agonist, --Tiotropium, smoking cessation, exercise, sometimes oxygen therapy

question

rhinitis

answer

inflammation of nasal mucosa, most frequently caused by allergic reactions or viruses;

question

viral rhinitis: the common cold

answer

self-limiting, infectious, communicable; --best treated conservatively, --NSAIDs for aches and pains, --decongestants helpful

question

allergic rhinitis

answer

risk factor for development of asthma and nasal polyps; --most symptoms due to release of histamine from mast cells and basophils, --H1, H2 or H3 histamine receptors

question

H1 receptors on smooth muscle of bronchi, veins, capillaries, heart, GI tract;

answer

activation causes bronchoconstriction, vasodilation, constriction of intestinal smooth muscle, itching and pain

question

H2 receptors on brain, stomach, heart and blood vessels

answer

activation cause increase in gastric acid production, vasodilation, relaxation of smooth muscle; --not primarily involved in allergic reactions; --drugs for treatment of ulcers

question

H3 receptors on histamine-releasing cells

answer

presynaptic, upon stimulation inhibit histamine release

question

drugs to treat rhinitis

answer

antihistamines, a-adrenergic agonists, topical corticosteroids, mast cell stabilizers, --NOT antibiotics!

question

antihistamines --block H1 receptors, eliminating symptoms, sneezing, itcing, rhinorrhea, associated with common cold, but

answer

ineffective in treating common cold; --diphenhydramine/Benedryl 25 mg tabs OTC; --also treat allergic reactions and motion sickness; --2 types: first and second generation --histamine by itself has no clinical use;

question

antihistamines contraindicated in

answer

narrow-angle glaucoma, prostatic hypertrophy, stenosing peptic ulcer disease, bladder obstruction --because they have anticholinergic properties

question

antihistamine adverse side effects

answer

many, because they are not selective to bronchioles; --because of anticholinergic activity, --dry mouth, blurred vision, tachycardia, urinary retention

question

first generation antihistamines: sedating

answer

diphenhydramine/Benedryl, chlorpheniramine/Chlor-Trimeton, dimenhydrinate/Dramamine; --may cause drowsiness and/or sedation, xerostomia, urinary retention

question

second generation: nonsedating antihistamines

answer

fexofenadine/Allegra, cetirizine/Zyrtec, loratadine/Claritin;

question

intranasal antihistamines

answer

azelastine/Astelin; --for symptoms of allergic rhinitis

question

if taking antihistamines, monitor anticholinergic side effects/dry mouth and

answer

consider home fluoride applications, monitor patient for caries, stress meticulous oral hygiene

question

alpha-agonists/nasal decongestants

answer

constrict blood vessels in nasal mucosa, reducing blood supply to nose and decreasing edema

question

OTC nasal decongestants

answer

oxymetazoline/Afrin; --rapid onset of action, but rebound effect after 3-5 days of use; --pseudoephedrine/Sudafed is systemic; use with caution in hypertensive patients

question

topical intranasal coticosteroids

answer

mometasone/Nasonex, fluticasone/Flonase, budesonide/Rhinocort; --reduce inflammation, --most effective for relieving sneezing, itching, congestion and rhinorrhea, --possible diminished growth in children

question

topical/intranasal corticosteroids: nasal sprays

answer

beclomethasone/Beconase, budesonide/Rhinocort; --relieve symptoms of sneezing, itching, congestion, rhinorrhea

question

OTC nasal sprays

answer

cromolyn/Nasalcrom and nedocromil/Tiladle; --have anti-inflammatory activity, --also for treatment of asthma and allergic rhinitis

question

anticholinergic: ipratropium/Atrovent is a bronchodilator applied as a nasal spray

answer

approved for asthma and rhinitis, but does not relieve nasal congestion

question

drugs for cough: antitussives

answer

act by depressing cough center in brain; --drugs include codeine, hydrocodone, hydromorphone, dextromethorphan; --codeine is gold standard, but use with caution in asthma patients because of risk of respiratory depression

question

expectorants

answer

stimulate production of a watery, less viscous mucous; --guaifenesin/Mucinex --works by irritating the gastric mucosa, which stimulates respiratory secretions; --water is an effective expectorant

question

DH applications: if patient has asthma, ask

answer

if have had recent symptoms, what therapy taking, date of last severe attack; --if using an inhaler, it should be used before appointment and available throughout

question

if taking systemic corticosteroid like prednisone

answer

more than 20 mg a day, or lower dose for 14 days or longer, may alter immunity; --take this into account when scheduling invasive procedures

question

aspirin and NSAIDs may be contraindicated in patients, especially children, with asthma

answer

drugs can precipitate or exacerbate an asthma-induced bronchospasm

question

educate patients about anticholinergic side effects of first generation antihistamines

answer

symptoms of dry mouth; --drink lots of water, avoid alcohol and alcohol-containing mouth rinses

question

1. After which of the following drugs used to treat asthma should the DH instruct patient to rinse mouth? --ipratropium, cromolyn sodium, beclomethasone, theophylline

answer

c. beclomethasone, an inhaled corticosteriod. --also with ipratropium, an anticholinergic?? --cromolyn sodium is a mast cell stabilizer, --theophylline a methylxanthine

question

2. Which of the following drugs may be contraindicated in asthmatics? --aspirin, acetaminophen, vitamin C, folic acid

answer

a. aspirin, because of GI problems

question

3. Which of the following drugs is drug of choice for the quick relief of bronchospasm? --albuterol, ipratropium, hydrocortisone, salmeterol

answer

a. albuterol, --ipratropium/Atrovent is anticholinergic rescue inhaler, should not be used alone; hydrocortisone is oral corticosteroid, salmeterol is for long-term control

question

4. Which of the following drugs is classified as a B2 agonist bronchodilator? --albuterol, ipratropium, hydrocortisone, montelukast

answer

a. albuterol --ipratropium/Atrovent an anticholinergic, hydrocortisone an oral corticosteriod, montelukast a leukotriene modifier

question

5. Which of the following drugs is used to control mild persistent asthma? --albuterol, ipratropium, inhaled beclomethasone, salmeterol

answer

c. inhaled beclomethasone, a low-dose ICS; --albuterol is rescue inhaler, --ipratropium is anticholinergic, --Salmetrol is LABA

question

6. Which of the following has anticholinergic effects? --loratadine, fexofenadine, diphenhydramine, azelastine

answer

c. diphenhydramine, a first generation antihistamine loratadine/Claritin, a 2nd gen antihistamine, fexofenadine/Allegra, a 2nd gen antihistamine, azelastine is an intranasal antihistamine

question

7. Which of the following drugs is preferred for long-term control of asthma? --B1 receptor agonist, B2 receptor agonist, inhaled corticosteroids, oral corticosteroids

answer

c. inhaled corticosteroids

question

8. Which of the following adverse effects occurs with antihistamines? --dry mouth, increased salivation, dry skin, moist skin

answer

a. dry mouth

question

9. Which of the following terms defines "suppressing a cough"? --expectorant, antitussive, antihistamine, antiasthma

answer

b. antitussive,

question

10. Which of the following types of agents are nasal decongestants? --B1 receptor agonists, B2 receptor blockers, A1 receptor agonist, A2 receptor blocker

answer

c. A1 receptor agonist

Ch. 13: Respiratory Drugs – Flashcards

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